Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, August 05, 2008

Postcard

Hoping I can get this post done before the jodido wireless networks here kick me off. I've got more to say than I can tell you about the conference, but first let me give you my gringo turista view of Mexico City.

I'm staying in the upscale, touristy, and heavily policed Zona Rosa; and the route to the Banamex Center takes us along the Paseo de la Reforma, through gorgeously maintained parks, past the botanical garden, and the zoo, modern high-rise office buildings, and an extravagant display of public sculpture. The conference center is next to the hippodrome and a theme park. Somehow, I have the feeling I'm not getting a totally unbiased impression of the city.

Mexico City is one of the world's largest cities in population, and in fact the largest in geographic extent. Most of it, of course, is quite impoverished and some of it consists of miserable slums without proper sewage or electricity. A tourist visting Boston, of course, wouldn't be likely to see our poor neighborhoods either; and in contrast, would not see anything as magnificent as the Paseo de la Reforma, although I suppose Washington D.C. offers comparable grandeur (along with worse poverty and slums than Boston.) Mexico truly is a developing country, not an undeveloped one. It has a middle class, effective government, and a growing economy, but it has a long way to go.

The Banamex Center is municipally owned, and it appears to be part of a strategy to soak up unemployment that reminds me of the old Soviet hot dog stands, where one guy would put the hot dog in the bun, one guy would put on the mustard, another guy would hand you the napkin and the fourth would take your money. Getting anything to eat here is a half hour ordeal of waiting in line, and at the end of it the food is all prefab and pretty dull. (Not even Mexican, by the way -- it's tuna sandwiches and chef's salads.) Once you get to the front, one person hands you the beverage, another takes your order, a third consolidates the drink with the sandwich, another one aggregates the chips or cookie, and then there's the cashier. But she doesn't take your money. A guy standing in front of the counter in a suit takes the money and hands it to the cashier, then hands you the change. He seems to be in charge, although he has nothing particularly to supervise.

The buses that bring us from our hotels are waved through to the infield of the hippodrome by a small army of functionaries, even though the bus drivers already know where they're going. The way they mow the lawn is to have two guys meticulously sweeping weed wackers while two other guys with brooms carefully remove the clippings.

I expect that private industry here is as efficient as it is anywhere else, but there's a lot of unemployment and the government is obviously trying to do something about all the people who graduate from college and have no work waiting for them. It obviously isn't enough and social stability here is a bit fragile. There is also a terrible problem with crime, much of it commited by the police, as today's copy of Reforma informs us at length. In fact, the Mexico City police harbor a kidnapping ring.

You may have heard that tourists can expect everyone to speak English, but that is not true. Even the hotel bartenders and bellmen may be far from fluent. Mexico is holding onto its language fiercely, but it is also reforming its culture. The government for some years has been running an anti-machismo and anti-homophobia campaign, and you can see the billboards around the city. Women are far from achieving equality here, but there are more and more female professionals and public officials, and violence against women is less and less acceptable.

Mexico would be unequivocally on the way up except for two major problems. One is crime, and the profound corruption of law enforcement. That's really tough to solve. What are you gonna do, have the police arrest themselves? The second is that oil depletion. Mexico's economic development has been built on petroleum but they're running out. Once they don't have enough to export, they're going to be in trouble unless they can diversify their export industries, fast and big time. They're trying - one of the front page stories in Reforma is about a new foundry. (Bill Clinton's visit and this conference are also big news, of course.)

Economic opportunity in Mexico is the answer to our own bitter struggles over immigration, of course. Most Estadounidensias seem to have no understanding that the fates of our countries are closely linked. What's good for Mexico is good for the U.S. The leadership here seems to understand its challenges but whether they can beat them remains to be seen. It's going to be close.